MEDICARE: MR. ANTHONY OGBODO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95002864	CA

General Provider Information

NPI Number	:	1063884625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY OGBODO

Provider Business Mailing Address
First Line	:	2471 NORTH NAGLEE ROAD
Second Line	:	SUITE 100 #1037
City	:	TRACY
State	:	CA
Zip	:	95304-3519
Country	:	US
Telephone Number	:	510-755-3004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2471 NORTH NAGLEE ROAD
Second Line	:	SUITE 100 #1037
City	:	TRACY
State	:	CA
Zip	:	95304-3519
Country	:	US
Telephone Number	:	510-755-3004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	12/12/2024

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Directions to “ MR. ANTHONY OGBODO ” Practice Location

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